The peripartum breastfeeding rate among low-income women who participate in the Supplemental Food Program for Women, Infants and Children (WIC) has declined over 13% since 1984, to 34.2%. Duration of breastfeeding is also short within this population. Health Objectives for the year 2000 prescribe a 75% in-hospital rate, and Public Law l01-147 mandates eight million dollars to be spent annually within the WIC system to promote breastfeeding. There is an urgent need to develop cost-effective breastfeeding promotion programs to achieve these goals. Through focus groups of rural North Carolina mothers enrolled in WIC, factors that affect the nature and timing of breastfeeding decision making, and potential role of nursery discharge packs have been identified. Based on a review of past interventions and focus group findings, innovative newborn nursery discharge packs, teaching strategies and instruments for breastfeeding promotion have been developed. Effectiveness of these low-cost interventions will be tested using a 2 X 2 factorial randomized controlled trial in 6 WIC clinics, and the local University teaching hospital where the study population obtains obstetric care. Breastfeeding incidence and duration will be determined through newborn nursery chart review, and telephone follow-up at 2 weeks, 2 months and 4 months. Broad aims of this study are to provide important health services information about breastfeeding promotion among low-income women in the WIC system, and hospital policies regarding nursery discharge packs. Secondary aims are to provide new information about maternity leave policies that may affect breastfeeding among this population. This study was begun with start-up funding from North Carolina WIC. The Project Director position has been filled by the Principal Investigator supported by a National Research Service Award Primary Care Research Fellowship which ends June 30, 1992. Other funding must be obtained to allow completion of the study, which serves as the dissertation project for the Principal Investigator in the Department of Epidemiology at the School of Public Health, University of North Carolina, expected in June, 1993.